Everyone checks themselves in the mirror now and then, but that experience can be horrifying for individuals suffering from body dysmorphic disorder, or BDD, a psychiatric condition that causes them to believe, wrongly, that they appear disd and ugly. These people tend to fixate on minute details -- every tiny blemish looms huge -- rather than viewing their face as a whole.
Now researchers at UCLA have determined that the brains of people with BDD have abnormalities in processing visual input, particularly when examining their own face. Further, they found that the same systems of the brain are overactive in both BDD and obsessive-compulsive disorder, suggesting a link between the two. The research appears in the February issue of the journal Archives of General Psychiatry.
"People with BDD are ashamed, anxious and depressed," said Dr. Jamie Feusner, an assistant professor of psychiatry and lead author of the study. "They obsess over tiny flaws on their face or body that other people would never even notice. Some refuse to leave the house, others feel the need to cover parts of their face or body, and some undergo multiple plastic surgeries. About half are hospitalized at some point in their lifetimes, and about one-fourth attempt suicide."
Despite its prevalence -- BDD affects an estimated 1 to 2 percent of the population -- and severe effects, little is known about the underlying brain abnormalities that contribute to the disease.
To better understand its neurobiology, Feusner and colleagues examined 17 patients with BDD and matched them by sex, age and education level with 16 healthy people. Participants underwent functional magnetic resonance imaging (fMRI) while viewing photographs of two faces -- their own and that of a familiar actor -- first unaltered, and then altered in two ways to parse out different elements of visual processing.
One altered version included only high-spatial frequency information, which would allow detailed analysis of facial traits, including blemishes and hairs. The other showed only low-spatial frequency information, conveying the general shape of the face and the relationship between facial features.
Compared to the control participants, individuals with BDD demonstrated abnormal brain activity in visual processing systems when viewing the unaltered and low-spatial frequency versions of their own faces. They also had unusual activation patterns in their frontostriatal systems, which help control and guide behavior and maintain emotional flexibility in responding to situations.
Brain activity in both systems correlated with the severity of symptoms. In addition, differences in activity in the frontostriatal system varied based on participant reports of how disgusting or repulsive they found each image. Basically, how ugly the individuals viewed themselves appeared to explain abnormal brain activity in these systems.
The abnormal activation patterns, especially in response to low-frequency images, suggest that individuals with body dysmorphic disorder have difficulties perceiving or processing general information about faces.
"This may account for their inability to see the big picture -- their face as a whole," Feusner said. "They become obsessed with detail and think everybody will notice any slight imperfection on their face. They just don't see their face holistically."
Some of the patterns, said Feusner, also appear to be similar to those observed in patients with obsessive-compulsive disorder, supporting hypotheses that the two conditions share similar neural pathways. However, future studies are needed to further elucidate the causes and development of body dysmorphic disorder.
Other authors on the paper include Teena Moody, Emily Hembacher, Jennifer Townsend, Malin McKinley, Hayley Moller and Susan Bookheimer, all of UCLA.
The research was supported by the National Institute of Mental Health, the Obsessive-Compulsive Foundation, a research grant from UCLA, the National Center for Research Resources, the National Institutes of Health, the Brain Mapping Medical Research Organization, the Brain Mapping Support Foundation, the Pierson-Lovelace Foundation, the Ahmanson Foundation, the William M. and Linda R. Dietel Philanthropic Fund at the Northern Piedmont Community Foundation, the Tamkin Foundation, the Jennifer Jones-Simon Foundation, the Capital Group Companies Charitable Foundation, the Robson Family and the Northstar Fund.
FAQs
Now researchers at UCLA have determined that the brains of people with BDD have abnormalities in processing visual input, particularly when examining their own face. Further, they found that the same systems of the brain are overactive in both BDD and obsessive-compulsive disorder, suggesting a link between the two.
How does body dysmorphic disorder affect the brain? ›
This suggests that emotional brain systems in those with BDD, compared with healthy controls, may more strongly influence visual systems. This could result in enhanced visual detail perception – noticing small imperfections – which those without BDD tend not to notice.
What is mirror gazing in body dysmorphic disorder? ›
Individuals with body dysmorphic disorder are compulsively drawn to the mirror, checking the mirror to ease their fears about how they think they look or continuously checking to see if their perceived deformity is still there or has become worse.
Does body dysmorphia affect how you see yourself? ›
Symptoms of body dysmorphic disorder (BDD)
look at yourself in mirrors a lot or avoid mirrors altogether. go to a lot of effort to conceal flaws – for example, by spending a long time combing your hair, applying make-up or choosing clothes. pick at your skin to make it "smooth"
Is body dysmorphia a distorted body image? ›
Body dysmorphic disorder is a mental health condition in which you can't stop thinking about one or more perceived defects or flaws in your appearance — a flaw that appears minor or can't be seen by others. But you may feel so embarrassed, ashamed and anxious that you may avoid many social situations.
How does body image affect the brain? ›
People with negative body image are more likely to have an eating disorder and more frequently suffer from negative emotions such as depression, isolation, loss of self-confidence, obsession with weight loss. Obesity is also a risk factor for anxiety disorders.
Does body dysmorphia affect how you see photos? ›
When viewing themselves in photographs, patients with BDD underutilize parts of the brain used in seeing the face's overall shape and size, he said. "If you just see the pieces of your face, and not seeing how they fit into the whole, then it's going to look distorted," he said.
Why do people with BDD avoid mirrors? ›
Try not to be seen. Some people feel so bad about their looks that they don't want to be seen. They may stay home; keep to themselves; or use makeup, hats, or clothes to cover up. They may also avoid looking in mirrors because it's so stressful.
Why do people look in the mirror a lot? ›
We use the mirror as we do face-to-face communication: to get feedback on who we are and what we are experiencing in the moment. A quick glance in the mirror reaffirms our sense of self. Mirrors help us regulate our emotions and sync up with ourselves and others. Mirrors simulate face-to-face contact with others.
How a person with body dysmorphia see themselves? ›
One of the most conspicuous symptoms of BDD is the distorted perception of one's own appearance. For example, a person with BDD may believe his nose is crooked, or that he has acne scars all over his face, or that his hair is thinning.
People who have this illness constantly worry about the way they look. They may believe an inconspicuous or non-existent physical attribute is a serious defect. They respond to this by performing repetitive acts such as mirror checking or comparing their appearance with others. The severity of BDD varies.
Do people with body dysmorphia actually see themselves differently? ›
Now researchers at UCLA have determined that the brains of people with BDD have abnormalities in processing visual input, particularly when examining their own face. Further, they found that the same systems of the brain are overactive in both BDD and obsessive-compulsive disorder, suggesting a link between the two.
Is body dysmorphia delusional? ›
Individuals with BDD can receive an additional diagnosis of delusional disorder—somatic type, if their preoccupation with an imagined defect in appearance is held with a delusional intensity. Approximately 50% of patients with BDD meet the criteria in DSM-IV for a delusional disorder, somatic type.
What are the two types of body dysmorphia? ›
There are two subtypes of BDD: Muscle Dysmorphia and BDD by Proxy. Both of these subtypes appear to respond to the same basic treatment strategies as BDD (cognitive behavior therapy or CBT and medications). However, the CBT therapist in particular needs to adjust the treatment so that it has the right focus.
What is body dysmorphia linked to? ›
What causes body dysmorphic disorder? The cause of body dysmorphic disorder is thought to be a combination of environmental, psychological, and biological factors. Bullying or teasing may create or foster the feelings of inadequacy, shame, and fear of ridicule.
What are the long term effects of body dysmorphic disorder? ›
The fear of being judged creates avoidance of going into public and social isolation. Left untreated, BDD can lead to severe depression and suicidal thoughts and should not be ignored.
What causes body dysmorphia in the brain? ›
Fear of being rejected
If you worry about not fitting in, or being rejected or lonely, you may develop thought patterns that can lead to BDD. For example, if you believe that you need to look a certain way to maintain friends or find a partner, you may develop obsessive worries about your appearance.
How do people with BDD see themselves? ›
Feeling shame or disgust about your body or appearance, especially the specific things you think are problems. Some of the most common words people with BDD use to describe themselves or parts of their body include “ugly,” “hideous,” “deformed,” “abnormal,” “defective” or “unattractive.”
Is BDD a chemical imbalance? ›
A person with BDD has a genetic tendency to develop this type of mental illness. The trigger may be the stress of adolescence. Particular drugs, such as ecstasy, may trigger onset in susceptible people. BDD could be caused by chemical imbalances in the brain.
